From silence to dismissal; nursing managers’ strategies in dealing with nurses’ professional misconduct: a qualitative study

Professional misconduct in nursing can adversely affect patient safety, the quality of care, and public trust in the nursing profession. Nursing managers play a pivotal role in addressing such misconduct. This study aimed to explore the strategies used by nursing managers in Iran when dealing with professional misconduct committed by nurses. This qualitative study employed a content analysis approach for data collection and analysis. Fourteen semi-structured interviews were conducted with Iranian nursing managers. Participants were selected through purposive sampling. Data analysis led to the identification of three main categories and nine subcategories: Protective Strategies (supportive and preventive actions), Disciplinary Strategies (warnings, written commitments, reporting to superiors, punitive measures, and dismissal), and Biased Strategies (ignoring and counteractive measures). These categories represent the range of approaches that nursing managers employ when addressing nurses’ professional misconduct. Nursing managers employ a spectrum of strategies to address professional misconduct, ranging from protective (supportive and preventive) and disciplinary (warnings, reporting, dismissal) to biased (ignoring, counteractive measures). Given the exploratory nature of this study within a specific Iranian context, these findings highlight the need for structured, context-sensitive guidelines that differentiate between human error, at-risk behavior, and reckless conduct. Developing such frameworks may help mitigate biased responses, protect whistleblowers, and support managers in handling misconduct effectively, thereby contributing to the maintenance of professional integrity and the quality of care. Not applicable.